Page 132 - 2022 Spring JSOM

An Ongoing Series

Standardized Patient Methodology in Tactical Medical Education

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Nelson Tang, MD *; Kyle D. Jones, MD ;
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Stephanie J. Kemp, MD ; Joshua G. Knapp, NRP 4
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he historical impetus for the development of Tactical used to augment this type of tactical medical scenario training
Emergency Medical Support (TEMS) and the field of and may reduce some inconsistencies in addition to permitting
Ttactical medicine as a whole was the singular recognition invasive procedures.
of the extraordinary threat to operational personnel posed by
traumatic injuries. The effective provision of evidence-based FIGURE 1 Tactical medicine training emphasizes the physical
realism of scenario settings.
tactical casualty trauma care during high-threat incidents is
supported by the highest echelons of emergency medicine lead-
ership. Widely implemented training strategies in TEMS have
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appropriately focused on the field management of trauma and,
less commonly, select life-threatening medical emergencies.
There is emerging recognition, however, that the majority of
clinical encounters for some law enforcement tactical medi-
cal programs consists of lower acuity medical complaints. The
educational best practices to effectively train and adequately
prepare TEMS providers for these types of “sick call” clinical
encounters have not been well established.

TEMS Training (Photo courtesy of author NT.)
The current practice of tactical medicine is broadly represented
by a mixed cohort of provider types with varying scopes of
practice and clinical backgrounds. The need for informed con-
tinuous education of TEMS providers is very much aligned Clinical Encounters in TEMS
with the prioritization of training maintained by other public Prior work in TEMS research has demonstrated that the
safety disciplines. Realism in tactical medicine education is a breadth of actual clinical encounters within law enforcement
consistent objective and the focus of intensive efforts and ac- tactical medicine programs may not be as narrowly defined
tive development. Effective TEMS training encompasses both by traumatic injuries as previously believed. One study of a
the physical realism of actual scenario settings and the medical federal law enforcement agency tactical medical program
accuracy of the embedded, typically trauma oriented, clinical identified two distinct subgroups of clinical encounters: low-
problem sets (Figure 1).
frequency/high-acuity and high-frequency/low-acuity. These
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The patient portrayal in TEMS scenario-based training is clas- findings were consistent with those of a multiyear analysis
sically rendered by role players of variable experience and often of a state police tactical medical program. The role of tac-
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little to no formal training themselves in educational meth- tical medical providers in evaluating and managing non-life
odology. Depending upon resources and perceived relevance, threatening illnesses and injuries sustained by law enforcement
TEMS scenario role players typically consist of layperson vol- operational personnel is essential, serving to optimize the oper-
unteers, law enforcement officers, medical trainees, hospital ational readiness of these highly trained and specialized teams.
staff, or fellow TEMS providers. The intrinsic variability of
this approach is tolerated because the clinical problem set Clinical activities in tactical medicine that functionally im-
usually calls for technical management of localized injuries pact the “health of the unit” often require a knowledge base
and, much less commonly, evaluation of single-system medi- and training modalities beyond tactical scenario-based train-
cal complaints with generally limited differential diagnoses of ing focused narrowly on lifesaving interventions. While the
consequence. The use of high fidelity manikins is increasingly training approaches to high-acuity TEMS clinical encounters
*Correspondence to ntang@jhmi.edu
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1 Dr Nelson Tang, Dr Kyle D. Jones, and Dr Stephanie J. Kemp are affiliated with the Johns Hopkins University Center for Law Enforcement
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Medicine. Joshua G. Knapp is affiliated with the Bureau of Alcohol, Tobacco, Firearms and Explosives.
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